Pharmacists can help lower heart risk

With a more advanced scope of practice, pharmacists can achieve positive results for patients

A Canadian trial has shown intensive pharmacist intervention may help reduce cardiovascular risk in patients.

Community pharmacists in Alberta were engaged to recruit people at high risk of developing cardiovascular disease, such as those with diabetes and chronic kidney disease.

Of a total 723 participants, half received specialised care including medication review, CVD risk assessment and education, and monthly follow-up visits over three months.

Pharmacists also prescribed medications and ordered laboratory tests to achieve treatment targets in this group.

The remaining half of participants received usual pharmacist and GP care, with no specific intervention.

Results after three months revealed a 21% relative reduction in estimated risk for cardiovascular events compared to the control group.

There were also positive changes to individual risk factors. Compared to the control group, the intervention group had:

  • 9.37mm/Hg greater reduction in systolic blood pressure;
  • 0.92% greater improvement in glycaemic control;
  • 20% greater relative reduction in smoking; and
  • 0.2 mmol/l greater reduction in LDL cholesterol.

The results were published in the latest issue of the Journal of the American College of Cardiology.

“As the practice-based trial of an approach to cardiovascular risk reduction, we can only speculate that the improvements seen were due to changes in medication use, dosage adjustment, and improvement adherence to lifestyle and medications—all of which were enhanced by the guidelines-recommended follow-up visits performed by the pharmacists,” wrote the authors.

Kevin McNamara, a senior research fellow at Deakin University’s School of Medicine who has conducted trials in pharmacy-based hypertension management and cardiovascular risk reduction in Australia, says the results show Australia should continue working towards an expanded scope of practice for pharmacists.

“Australian pharmacists are underutilised, that’s probably not in dispute,” says McNamara.

“In Canada, pharmacists have got legislated a much more expanded scope of practice, where they can prescribe and order laboratory tests, and they can actually access test results as well from a central database. And they are indeed able to obtain remuneration from government for providing these services.

“It’s not feasible for Australian pharmacists to undertake many significant aspects of the published intervention. [However] if you look at the international evidence, you can see pretty clearly that when pharmacists are funded and empowered to conduct proper disease management around cardiovascular disease risk, that the patients achieve better outcomes,” he says.

To make those kinds of changes in Australia, you would need to get the GPs on board, he adds.

“One of the challenges we face in Australia is continuity of care between pharmacists and the general practice. So at the moment, community pharmacy can do a lot of the lifestyle measures.

“Where the challenge lies is when you require the GP or physician input to either order a lab test or to undertake prescribing. The first thing that causes the problem there is that it relies on a level of coordination between the GP and pharmacist, and it’s really difficult in our situation to have a model where the patient would return back to the pharmacy having gone to their GP,” he says.

Previous Australian research has demonstrated significantly reduced cardiovascular risk following pharmacist interventions, but without the type of scope of practice in the paper being described, McNamara adds.

Read the full study here

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